Fungal Acne vs Bacterial Acne: How to Spot the Difference

Not every inflammatory acne breakout is the result of bacterial growth. Some people have stubborn bumps on their face, back, or chest and think that’s regular acne (acne vulgaris) that can be cleared with acne medications or skincare topicals. Their assumption is wrong when their consistently used over-the-counter products provide no improvement. That could mean the underlying reason is different, most probably an overgrowth of fungus/yeast.

Whether it’s regular bacterial acne or fungal acne, properly identifying the cause/type of acne is very important. In this article, Dr. Niti Gaur, dermatologist in Gurgaon at Citrine Clinic explains how to spot the difference so the sufferer knows which treatment and skincare routine will work properly and can follow them without delay. A personalized acne assessment by a dermatologist is essential to make no mistakes in diagnosis and treatment.

Quick Summary About Fungal Acne vs Bacterial Acne

• Fungal acne is caused by Malassezia yeast, while Cutibacterium acnes causes bacterial acne.
• Fungal acne arises as uniform itchy bumps.
• Bacterial acne can present with papules, pustules, nodules, and cysts.
• Fungal acne typically affects the forehead, chest, back, and shoulders.
• Bacterial acne is more common on the face, jawline, chest, and back.
• The right treatment depends on the dermatologist's diagnosis.

What Causes Fungal Acne?

Fungal acne is not a typical acne breakout, but its appearance may mimic bacterial acne. In fact, it is an inflammatory dermatological concern that is clinically referred to as Malassezia folliculitis. The condition is caused by an overgrowth of naturally occurring fungus/yeast called Malassezia inside the hair follicles. Under hot and humid environmental conditions, Malassezia rapidly multiplies and causes itchy, follicular bumps.   

Things to know about Fungal Acne

• It is clinically known as: Malassezia folliculitis.
• Caused by: Overgrowth of Malassezia yeast in the hair follicles that leads to inflamed follicles
• Triggers: Hot humid weather, excessive sweating, tight clothing, oily skincare products, prolonged use of antibiotics, and a weakened immune system
• Symptoms: Uniform, itchy bumps
• Affected areas: Forehead, chest, shoulders, back, and upper arms
• Treatment: Oral or topical antifungals and proper skincare/healthy lifestyle.

What Causes Bacterial Acne?

Bacterial acne is the regular/true acne breakout, clinically referred to as acne vulgaris. It results from clogged pores with extra sebum, skin cell debris, impurities, and acne-causing bacteria. Oily skin is a major contributor to such acne, while other triggers include hormonal fluctuation, genetic predisposition, diet, stress, and certain cosmetics. Unlike fungal acne, this acne can manifest as various forms of inflammatory lesions at the same time. It ranges in severity from red, inflamed bumps to cystic lesions, so each type needs a targeted treatment.

Things to know about Fungal Acne

• It is clinically known as: Acne vulgaris.
• Caused by: Overgrowth of Cutibacterium acnes in pores plugged with excess sebum, dead skin cells, and impurities that lead to inflammation
• Triggers: Hormonal imbalance, oily skin, some dietary choices, genetics, stress, and exposure to pollutants
• Types: Papules, pustules, nodules, and cysts
• Common symptoms: Redness, inflammation, painful discomfort
• Affected areas: Face, chin, jawline, back, and chest
• Treatment options: Topical retinoids, benzoyl peroxide, salicylic acid, antibiotics, and oral medications for moderate to severe acne.

Fungal Acne vs Bacterial Acne: Quick Comparison

Here are the key distinguishing factors to consider:

Diagnosis of the Type of Acne

Self-diagnosis can be difficult, especially when fungal acne and bacterial acne have overlapping symptoms and both are present at a time. Most over-the-counter products or acne medications work on bacterial acne, not fungal acne. So, random treatments based on assumptions can worsen the lesions instead of clearing the skin if the acne type is misdiagnosed.

Consulting a dermatologist can lead to an accurate diagnosis and an appropriate treatment plan for clear skin.

The diagnosis is usually based on:

• Patient’s medical records- the symptoms' duration, sweating, recent use of antibiotics, and previous acne treatments
• Skin examination- the appearance and location of the breakouts
• Additional tests (if needed)- like skin scraping, microscopic examination, and laboratory testing.

Most Effective Treatment and Preventive Strategies Based on Acne Type

Treatments for fungal acne aim for reducing the overgrowth of Malassezia. Dermatologists may recommend:

• Antifungal creams, cleansers, or shampoos- for direct application on acne to inhibit fungal growth and calm inflammation
• Prescription oral antifungal- for moderate to severe, stubborn cases
• Opting for lighter formulations of skincare products in hot and humid weather
• Lifestyle modifications- including regular cleansing and wearing breathable clothes to avoid conditions that exacerbate fungal growth.

For bacterial acne, the treatment plan is customized based on the type and severity of lesions. Dermatologists may recommend:

• Topical treatments containing retinoids, salicylic acid, benzoyl peroxide, or antibiotics to inhibit bacterial growth, calm inflammation, and encourage skin cell turnover in mild cases
• Hormonal therapy in selected women with hormonal imbalance
• Oral antibiotic or isotreti-noin in moderate to severe cases
• Proper, consistent skincare regimen involving twice-daily gentle cleansing and avoidance of harsh/comedogenic products.